The opinion of the court was delivered by: COLLEEN McMAHON, District Judge
DECISION AND ORDER GRANTING DEFENDANT'S MOTION FOR SUMMARY
JUDGMENT AND DENYING PLAINTIFF'S CROSS-MOTION
Plaintiff, a computer programmer analyst at a computer
consulting firm, became unable to work and went on long-term
disability in February 2000, after complaining of chest pains and
blackouts brought on by work-related stress. Plaintiff was
subsequently diagnosed with arterial clogging in his chest and
legs and spinal compression, leading to pain symptoms in his
knees, legs, and lower back. At the same time, Plaintiff
underwent treatment for depression, memory loss and lowered
cognitive functions, and symptoms of rage and anger.
The terms of the Plaintiff's long-term disability insurance
plan stated that benefits for disability caused "to any extent"
by mental or nervous causes would be terminated after twenty-four
months. Defendant, pursuant to that plan, terminated benefits in
February, 2002. Plaintiff sought and received a reconsideration
of the termination; a final decision upholding termination was made in May 2002.
Plaintiff brought suit under 29 U.S.C. § 1132, which enables
civil actions for the enforcement of rights under an employee
benefit plan covered by the Employee Retirement Income Security
Act (ERISA). Upon submission of the administrative record and
affidavits by both sides, Defendant moved for summary judgment.
Plaintiff opposed and cross-moved for summary judgment as well.
For the reasons stated below, the Defendant's motion is GRANTED
and Plaintiff's cross-motion is DENIED.
Plaintiff was employed as a computer programmer analyst and
project manager at GRC International, a Virginia-based
corporation which provides technical consulting services to the
Department of Defense and other government agencies. AReid01313.
Prior to his employment at GRC in February, 1997, Plaintiff had
twenty-two years of experience as a programmer at IBM.
Plaintiff's Opposition to Defendant's Motion for Summary Judgment
and In Support of Cross-Motion for Summary Judgment
(hereinafter, "Opposition") at 2. His work as a programmer
analyst at GRC was described as 95% sedentary, with no lifting or
pulling, and no exposure to dangerous materials. AReid01310.
Prior to 1997, Plaintiff was relatively athletic and active,
engaging in running, recreational basketball, and other
activities. Areid00253. At the same time, he smoked two or more
packs of cigarettes a day, had not had a physical examination in
fifteen years, and appeared obese. Id. Through GRC, Plaintiff was covered by a Group Life and Accident
and Health Insurance Policy ("the Plan"), which included
long-term disability coverage, provided by Aetna Life Insurance
Co. (hereinafter, "Defendant"). See Affidavit of Maria
Piotrowski (hereinafter, "Affidavit") at ¶ 2 . The Plan is an
"employee benefit plan" under the terms of the Employee
Retirement Income Security Act (ERISA). 29 U.S.C. § 1101(a)
(2000). Disability for purposes of the Plan is defined as an
incapacity, "solely because of injury or disease, to perform the
material duties of your own occupation" for 36 months after the
time of injury. Areid01641. After thirty-six months, a claimant
must be shown to be unable to work in any reasonable
occupation, solely due to illness or disease, to continue
receiving benefits. Id. AReid01634,01642. However, long-term
disability benefits could be terminated after twenty-four months
if the disability is at that time caused to any extent by a
mental condition.*fn1 AReid01642-01643.
The Plaintiff's medical history, largely undisputed, is as
follows. In May 1997, Plaintiff first complained of pain in both
legs brought on by extensive walking or playing basketball.
Areid00262. This pain did not limit his range of joint motion.
Id. He was referred to Dr. Louise Reynolds of Vienna Family
Medicine, who diagnosed him as having claudication a reduced
flow of blood to the legs caused by arterial clogging. The
patient attempted chelation treatment ingestion of the chemical
EDTA to increase blood flow without surgery.*fn2 Areid00253.
In addition, he was diagnosed with high cholesterol and
non-insulin dependent diabetes mellitus, which he sought to control with prescription medications. Id.
Furthermore, Dr. Reynolds issued the Plaintiff a prescription for
a nicotine patch to control his cigarette addiction. Id.
Initially, the Plaintiff did not fully cooperate with his
medication regimen. Areid002490-0252. He did not begin to use the
patch, "intermittently" took medication for cholesterol, and
possibly ceased taking the prescribed diabetes medication.
Areid00248. By late 1998, although the initial symptoms of leg
pain had decreased, he reported new pain in the ball of his left
foot. AReid00245. He treated the pain with prescription
ibuprofen. Areid00242. In mid-1999, the symptoms of foot pain
apparently re-appeared, and were re-treated with ibuprofen by a
Dr. Cecil. Areid00242 There is no record of the Plaintiff's
raising his prior issues of high cholesterol or diabetes at this
In late 1999, Plaintiff, now a GRC project manager, was asked
to terminate two individuals under his employ as a cost-cutting
measure, a request which apparently caused him a significant
amount of stress and confusion. Areid00889. In October, he began
to suffer from chest pains, burning sensations in his left arm,
and numbness. AReid00240. On November 8, 1999, after Plaintiff
had fired one employee, GRC notified him that he would also be
let go. Areid00889. That event triggered increased chest pain and
an intense blackout; he was admitted to the emergency room at
Fairfax Inova Hospital complaining of chest pain, numbness, and
tenderness in the rib cage. Areid00379. A thallium scan detected
possible inferior ischemia reduced blood flow to the heart.
Id. Further analysis based on a November 11th
catheterization probe of his chest detected significant plaque in
the left coronary system, and a possible lesion in the right
coronary artery. Areid01236. The Plaintiff opted in favor of
non-invasive treatment rather than an angioplasty at this time.
Areid01237. As a result of his hospitalization, Plaintiff came under the
care of Dr. Kerry Prewitt for care of the pain in his legs. His
initial report notes that Plaintiff was still unable to walk more
than one or two blocks before onset of pain. Areid00075. On
January 14 and 21, 2000, successive femoral angioplasties were
performed on the Plaintiff's right and left legs to address the
reduced blood flow. Areid00114. The therapeutic effect of the
angioplasties was limited Plaintiff returned with complaints of
pain in his legs and left foot almost immediately afterwards.
Areid00112. Dr. Prewitt, at that time, concluded that the new
symptoms were not the product of claudication. Id.
Plaintiff subsequently sought treatment from Dr. Bruce Smith,
who evaluated the Plaintiff and diagnosed a herniated disk in his
back and compression of the spine. Areid00154. This finding was
confirmed by a September 18, 2000, MRI, which detected disk
herniation and mild stenosis painful pressure on the spinal
nerves by vertebrae. Areid00160. Dr. Smith also noted how
Plaintiff's ongoing depression constituted a risk factor and
could affect his ability to interact with physicians. Areid00154.
At this point, Plaintiff agreed to wait before moving to
consultation with an orthopedic surgeon. Id.
In a June 2000 letter, Dr. Prewitt indicated that the
Plaintiff's leg pain had spread, and now occurred while Plaintiff
was immobile. Areid00162. He also noted Plaintiff's unease with
the length of time the visit required, difficulty in remembering
drug dosages and prior diagnoses, and interest in chelation
therapy rather than repeated angiograms or angioplasties. Id.
By August, 2000, Plaintiff had come under the care of Dr. James
Melisi, a neurosurgeon. Dr. Melisi's complete file is not
included in the record provided. Opposition at 7. It appears,
however, that in May 2001, Dr. Melisi scheduled Plaintiff for a
laminectomy surgery on the vertebrae to remove pressure on the spinal nerves. Areid00063.
This operation was aborted after a pre-operative screening
detected Plaintiff's blood sugar level at over 600. Id. A
pre-operative report, dated May 7, 2000, by Dr. Harvey Sherber,
notes normal electrocardiogram results and some walking ability.
AReid00055-00058. Dr. Sherber also noted concern for Plaintiff's
long-term cardiovascular health. The laminectomy was successfully
performed two months later, and post-operative MRIs indicated a
clean prognosis and no need for additional spinal surgery.
Beginning in April 2001, Plaintiff complained of new pain in
his knee joints. He was referred to Dr. Christopher Annunziato,
who treated him with lidocaine injections in late April, 2001.
Areid00743. When these injections did not arrest the Plaintiff's
symptoms, he opted to undergo arthroscopic surgery on his right
knee on August 20, 2001. Areid00738. Similar surgery was planned
for the left knee, although never completed. Opposition at 9.
The arthroscopic surgery apparently had minimal impact on the
Plaintiff's pain symptoms. In his last patient report, Dr.
Annunziata observed continued pain, although also noted a range
of knee movement of up to 120 degrees. Areid00734. Plaintiff
entered physical therapy at Phyllis Moriarty & Associates in
January, 2002. His initial consultation showed intense lower back
and rear pain, limited leaning ability, and difficulty sleeping
on his back. Areid00674. Although it is not clear how long he
attended physical therapy, records indicate approximately a month
of constant attendance. Areid00677-00678. He subsequently began
treatment with Dr. Michael Vierio, a chiropractor, on February
11, 2002. Opposition at ...